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HIPPA Notice of Patient Privacy: file

For each, please confirm you are using the most up-to-date claim form for each insurance company:

To be reimbursed from Medicare, complete CMS Form 1490S: PATIENT’S REQUEST FOR MEDICAL PAYMENT (English/Spanish)

From BCBS: CLAIM FORM.

From UNITED HEALTHCARE: DIRECT MEDICAL REIMBURSEMENT FORM.

From CIGNA: DIRECT MEMBER REIMBURSEMENT FORM.

From AETNA: MEDICAL BENEFITS CLAIM REQUEST FORM.